Gestational diabetes mellitus (GDM) is a condition of high blood glucose levels are detected for the first trimester during pregnancy. GDM is very common and some studies have reported that 10-20% of pregnant women in India have GDM.

Who are at risk of GDM?

Older women
Overweight or obese.
Family history of diabetes
If there was a previous history of Gestational Diabetes.
Screening and diagnosis of hyperglycemia in pregnancy

All pregnant women should be screened at the first visit to antenatal clinic. Early in pregnancy screening is done usually at the booking visit to see if the woman already has diabetes complicating pregnancy which she did not know about. Screening can be done using either fasting plasma (FPG), glycosylated hemoglobin (A1C),or random plasma glucose(RPG). If a woman has high blood sugars early in pregnancy (FPG>7mmol/l (126 mg/dl), A1c >6.5% or RPG >11.1 mmol/l(200mg/dl) then she should be treated as having pre-existing diabetes.

All women who have normal blood glucose levels of sugar early in pregnancy should be screened again with an oral glucose tolerance test (OGTT) between 24-28 weeks of the pregnancy to rule out GDM. They should come to the centre in fasting state at least 8 hrs-10 hrs and should not consume anything except water before the test. Fasting blood and urine are collected, 75 gms of oral glucose is given to drink in 300 ml of water. Blood is then drawn at one and two hrs of the glucose load. If fasting plasma glucose is between 92-125mg/dl or 1 hr of glucose load >180mg/dl or 2 hrs level is >153mg/dl (International Association of Diabetes and Pregnancy Study Group, IADPSG criteria) the woman is said to have Gestational Diabetes.

Weight gain during pregnancy

All pregnant women should gain some weight during pregnancy and the recommended weight gain is decided by the Pre-pregnancy body mass index (BMI)

BMI = Weight (kg)/ Height in m2

Changes of body weight based on BMI

< 18.5 Underweight
18.5-22.9 Normal
23-24.9 Overweight
>25 Obese
(According to Asian Indian guidelines1)

Recommended weight gain according to pre pregnancy BMI

BMI Weight gain
<18.5 12.5-18 Kg
18.5-24.9 11.5-16 KG
25-29.9 7-11.5 KG
>30.0 5-7 KG
Managing Gestational Diabetes

Gestational Diabetes levels can be managed through balanced and healthy diet, medication and exercise. Medication is usually indicated if blood sugars do not come to normal with diet and exercise. Recommended levels of glucose are fastingGeneral guidelines for healthy eating

Generally good nutrition is important during pregnancy and en effective way to manage gestational diabetes levels. A dietitian can guide to take portion size, right amount of protein, fat and carbohydrate.

Here are some general tips:-

Eat variety of foods distributing calories, carbohydrate and taking enough protein
4-5 serving of vegetables is recommended
Adequate fluids 2-3 liters should be taken but however water has to be restricted if there is pedal edema.
Iron rich foods should be included. Eg: – Greens
Consume 650 ml of milk/ day to meet calcium requirements.
Avoid direct sugars, artificial sweeteners.
Avoid Alcohol and tobacco.
Use a combination of oils Eg: – Mono unsaturated fats and Poly unsaturated fats
Include plant protein like pulses, dhal etc.
Restrict animal protein like red meat.
Healthy plate

One way to decide how much to eat to divide the plate is given below. Up to half plate should contain vegetables and fruits, about one quarter of plate should be starch or grains and the reminder protein and calcium rich foods.

Physical Activity

Aerobic activity of moderate intensity for 30mins/day on most days of the week has shown benefits in metabolic control. Start with light to moderate exercise. Any simple physical activity is better than no activity.


Insulin is indicated when target blood glucose levels are not attained with diet and physical activity. Different types of insulin is prescribed by the Diabetologist.

Materials required for insulin injection

Syringe or pen type needle.
Denatured spirit
General guidelines for patient on bottle type insulin

Insulin must be refrigerated, not frozen
Store away from heat
It must be rolled between two hands before using.
Common site for taking Insulin are upper part of thigh. You may not want to use abdomen during pregnancy, hence arms and legs are preferred.
If refrigerator not available (ex. in villages) Insulin can be stored in clay pot.
Each bottle type contains 400 units
If using 100 u insulin then use a 100u syringe
If using 40u insulin then use a 40u syringe.
General guidelines for patients on pen type insulin

The pens can be stored at room temperature while in use.
Should not get exposed to direct sunlight
Pen needle can be used 4-5 times without sterilization.
Each pen contains 300 units of insulin.
Insulin pens are available in two basic types, disposable and reusable.
Insulin pens are portable,discreet and convient to carry,
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